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Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

BACKGROUND: Impaired left ventricular (LV) ejection fraction is a common finding in patients with aortic stenosis and serves as a predictor of morbidity and mortality after transcatheter aortic valve replacement. However, conflicting data on the most accurate measure for LV function exist. We wanted...

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Autores principales: Mangner, Norman, Stachel, Georg, Woitek, Felix, Haussig, Stephan, Schlotter, Florian, Höllriegel, Robert, Adam, Jennifer, Lindner, Anna, Mohr, Friedrich W., Schuler, Gerhard, Kiefer, Philipp, Leontyev, Sergey, Borger, Michael A., Thiele, Holger, Holzhey, David, Linke, Axel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015421/
https://www.ncbi.nlm.nih.gov/pubmed/29654191
http://dx.doi.org/10.1161/JAHA.117.007977
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author Mangner, Norman
Stachel, Georg
Woitek, Felix
Haussig, Stephan
Schlotter, Florian
Höllriegel, Robert
Adam, Jennifer
Lindner, Anna
Mohr, Friedrich W.
Schuler, Gerhard
Kiefer, Philipp
Leontyev, Sergey
Borger, Michael A.
Thiele, Holger
Holzhey, David
Linke, Axel
author_facet Mangner, Norman
Stachel, Georg
Woitek, Felix
Haussig, Stephan
Schlotter, Florian
Höllriegel, Robert
Adam, Jennifer
Lindner, Anna
Mohr, Friedrich W.
Schuler, Gerhard
Kiefer, Philipp
Leontyev, Sergey
Borger, Michael A.
Thiele, Holger
Holzhey, David
Linke, Axel
author_sort Mangner, Norman
collection PubMed
description BACKGROUND: Impaired left ventricular (LV) ejection fraction is a common finding in patients with aortic stenosis and serves as a predictor of morbidity and mortality after transcatheter aortic valve replacement. However, conflicting data on the most accurate measure for LV function exist. We wanted to examine the impact of LV ejection fraction, mean pressure gradient, and stroke volume index on the outcome of patients treated by transcatheter aortic valve replacement. METHODS AND RESULTS: Patients treated by transcatheter aortic valve replacement were primarily separated into normal flow (NF; stroke volume index >35 mL/m(2)) and low flow (LF; stroke volume index ≤35 mL/m(2)). Afterwards, patients were divided into 5 groups: “NF–high gradient,” “NF–low gradient” (NF‐LG), “LF–high gradient,” “paradoxical LF‐LG,” and “classic LF‐LG.” The 3‐year mortality was the primary end point. Of 1600 patients, 789 (49.3%) were diagnosed as having LF, which was characterized by a higher 30‐day (P=0.041) and 3‐year (P<0.001) mortality. LF was an independent predictor of all‐cause (hazard ratio, 1.29; 95% confidence interval, 1.03–1.62; P=0.03) and cardiovascular (hazard ratio, 1.37; 95% confidence interval, 1.06–1.77; P=0.016) mortality. Neither mean pressure gradient nor LV ejection fraction was an independent predictor of mortality. Patients with paradoxical LF‐LG (35.0%), classic LF‐LG (35.1%) and LF–high gradient (38.1%) had higher all‐cause mortality at 3 years compared with NF–high gradient (24.8%) and NF‐LG (27.9%) (P=0.001). However, surviving patients showed a similar improvement in symptoms regardless of aortic stenosis entity. CONCLUSIONS: LF is a common finding within the aortic stenosis population and, in contrast to LV ejection fraction or mean pressure gradient, an independent predictor of all‐cause and cardiovascular mortality. Despite increased long‐term mortality, high procedural success and excellent functional improvement support transcatheter aortic valve replacement in patients with LF severe aortic stenosis.
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spelling pubmed-60154212018-07-05 Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement Mangner, Norman Stachel, Georg Woitek, Felix Haussig, Stephan Schlotter, Florian Höllriegel, Robert Adam, Jennifer Lindner, Anna Mohr, Friedrich W. Schuler, Gerhard Kiefer, Philipp Leontyev, Sergey Borger, Michael A. Thiele, Holger Holzhey, David Linke, Axel J Am Heart Assoc Original Research BACKGROUND: Impaired left ventricular (LV) ejection fraction is a common finding in patients with aortic stenosis and serves as a predictor of morbidity and mortality after transcatheter aortic valve replacement. However, conflicting data on the most accurate measure for LV function exist. We wanted to examine the impact of LV ejection fraction, mean pressure gradient, and stroke volume index on the outcome of patients treated by transcatheter aortic valve replacement. METHODS AND RESULTS: Patients treated by transcatheter aortic valve replacement were primarily separated into normal flow (NF; stroke volume index >35 mL/m(2)) and low flow (LF; stroke volume index ≤35 mL/m(2)). Afterwards, patients were divided into 5 groups: “NF–high gradient,” “NF–low gradient” (NF‐LG), “LF–high gradient,” “paradoxical LF‐LG,” and “classic LF‐LG.” The 3‐year mortality was the primary end point. Of 1600 patients, 789 (49.3%) were diagnosed as having LF, which was characterized by a higher 30‐day (P=0.041) and 3‐year (P<0.001) mortality. LF was an independent predictor of all‐cause (hazard ratio, 1.29; 95% confidence interval, 1.03–1.62; P=0.03) and cardiovascular (hazard ratio, 1.37; 95% confidence interval, 1.06–1.77; P=0.016) mortality. Neither mean pressure gradient nor LV ejection fraction was an independent predictor of mortality. Patients with paradoxical LF‐LG (35.0%), classic LF‐LG (35.1%) and LF–high gradient (38.1%) had higher all‐cause mortality at 3 years compared with NF–high gradient (24.8%) and NF‐LG (27.9%) (P=0.001). However, surviving patients showed a similar improvement in symptoms regardless of aortic stenosis entity. CONCLUSIONS: LF is a common finding within the aortic stenosis population and, in contrast to LV ejection fraction or mean pressure gradient, an independent predictor of all‐cause and cardiovascular mortality. Despite increased long‐term mortality, high procedural success and excellent functional improvement support transcatheter aortic valve replacement in patients with LF severe aortic stenosis. John Wiley and Sons Inc. 2018-04-13 /pmc/articles/PMC6015421/ /pubmed/29654191 http://dx.doi.org/10.1161/JAHA.117.007977 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research
Mangner, Norman
Stachel, Georg
Woitek, Felix
Haussig, Stephan
Schlotter, Florian
Höllriegel, Robert
Adam, Jennifer
Lindner, Anna
Mohr, Friedrich W.
Schuler, Gerhard
Kiefer, Philipp
Leontyev, Sergey
Borger, Michael A.
Thiele, Holger
Holzhey, David
Linke, Axel
Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title_full Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title_fullStr Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title_full_unstemmed Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title_short Predictors of Mortality and Symptomatic Outcome of Patients With Low‐Flow Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
title_sort predictors of mortality and symptomatic outcome of patients with low‐flow severe aortic stenosis undergoing transcatheter aortic valve replacement
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015421/
https://www.ncbi.nlm.nih.gov/pubmed/29654191
http://dx.doi.org/10.1161/JAHA.117.007977
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